Background
The global standard of care for Celiac Disease (CD) mandates lifelong adherence to a certified Gluten-Free Diet (GFD). However, international consensus guidelines largely reflect Western dietary paradigms, relying on expensive, commercially processed gluten-free products that are economically inaccessible or unavailable across LMICs. While indigenous staples (sorghum, millet etc.) are naturally gluten-free and culturally embedded, their therapeutic potential is undermined by unregulated commercial milling cross-contamination and a lack of LMIC-tailored dietary frameworks.
Methods
A comprehensive search was conducted across PubMed, Web of Science, Google Scholar, FAO/WHO Codex Alimentarius databases, and regional health repositories (2000–2026). Literature evaluating the prolamin safety profile of indigenous non-gluten grains, quantitative gluten cross-contamination (R5/G12 ELISA metrics), local grain-processing protocols, and socio-economic barriers to GFD compliance in LMICs was critically synthesized into a thematic policy framework.
Results
Evidence from previous studies confirms that storage prolamins in indigenous grains lack the immunogenic sequences capable of triggering HLA-DQ2/DQ8-mediated T-cell activation in CD patients. However, supply chain mapping identifies shared commercial hammer-milling as the primary cross-contamination bottleneck, elevating gluten levels in naturally GF flours above the safe 20 ppm Codex threshold. Literature demonstrates that low-cost, decentralized processing interventions, specifically dedicated communal mills, validated mechanical air-flushing, or local wash-and-sieve routines consistently reduce gluten contamination below 5 ppm. Clinical and nutritional studies show that CD patients maintained on regulated indigenous grain diets achieve mucosal healing, serological normalization, and micronutrient recovery comparable to commercial GFD cohorts, at less than 15% of the household financial burden.
Conclusion
Relying on imported commercial gluten-free foods is an unviable long-term management strategy for CD in LMICs. Harnessing naturally gluten-free indigenous crops provides a nutritionally rich, culturally acceptable, and economically viable therapeutic alternative. We present the "LMIC-GFD Implementation Framework," outlining clinical, processing, and national policy actions required to safely integrate indigenous grains into celiac care.